• J Shoulder Elbow Surg · Sep 2017

    Comparative Study

    Reverse shoulder arthroplasty compared with hemiarthroplasty in the treatment of acute proximal humeral fractures.

    • Michael van der Merwe, Matthew J Boyle, Frampton Christopher M A CMA Department of Medicine, The University of Otago, Christchurch, New Zealand., and Craig M Ball.
    • Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand; Auckland Bone and Joint Surgery, Auckland, New Zealand. Electronic address: michaelvdm@gmail.com.
    • J Shoulder Elbow Surg. 2017 Sep 1; 26 (9): 1539-1545.

    BackgroundComplex proximal humeral fractures may require prosthetic replacement of the humeral head. Surgical options include reverse shoulder arthroplasty (RSA) and shoulder hemiarthroplasty; however, the optimal technique remains controversial. The goal of this study was to compare functional outcomes and revision rates of RSA with hemiarthroplasty in patients with acute proximal humeral fractures.Materials And MethodsBetween January 1, 1999, and December 31, 2014, there were 218 patients who underwent RSA and 427 who underwent hemiarthroplasty for acute proximal humeral fractures identified through New Zealand Joint Registry records. Study groups were compared with regard to baseline characteristics, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS], revision rate, mortality rate) at 6 months and 5 years after surgery.ResultsRSA patients were significantly older (mean age, 78.2 vs. 71.6 years; P < .001), with a higher proportion of female patients (90% vs. 77%; P < .001) than in the hemiarthroplasty group. No statistically significant difference existed in revision rate per 100 component-years (0.58 [RSA] vs. 1.16 [hemiarthroplasty]; P = .137) or 1-year mortality (3.8% vs. 3.4%; P = .805) between both groups. There was no significant difference in 6-month OSS (29.6 vs. 28.4; P = .305). The RSA group demonstrated a superior mean 5-year OSS (37.6 vs. 32.7; P = .078); however, the difference did not achieve statistical significance.ConclusionsAlthough our results suggest that RSA patients may experience superior 5-year functional scores, we have identified no significant difference in functional outcomes and revision rates between RSA and hemiarthroplasty in the treatment of acute proximal humeral fractures.Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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